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Reviewed by Jane L. Parpart (Department of International Development Studies, Dalhousie University)Published on H-SAfrica (May, 2004)

AIDS, Sexuality, and Gender in Africa, edited by Janet Bujra and the late Carolyn Baylies, with support from the Gender and AIDS Group, is an important contribution to the growing literature on AIDS in Africa. This literature has generally been more focused on the way AIDS has affected African societies and economies rather than the social patterns that have fueled the current pandemic.[1] When causes are examined, they tend to focus on poverty and human insecurity rather than gender and sexuality. This book is a welcome correction. It explores the gendered dimensions of AIDS, particularly the impact of gendered cultural assumptions, practices, and hierarchies on the AIDS pandemic in Africa. The research was carried out by a team of scholars and activists from Tanzania, Zambia, and Britain led by Marjorie Mbilinyi (Tanzania), Beatrice Liatto-Katundu (Zambia), and Janet Bujra and Carolyn Baylies (United Kingdom). The research was carried out in six communities (urban and rural), three in Tanzania and three in Zambia. It explores community organizations as well as individual attitudes and behavior. The book thus provides the "thick description" needed to evaluate gender roles and relations and their impact on AIDS transmission and management by individuals and communities. At the same time, the researchers deliberately placed their analysis of the AIDS pandemic in wider social, political, and economic contexts, recognizing that the spread of AIDS has been affected by the growth of migration, urbanization, widespread poverty, and selling sex for economic survival, as well as gendered and generational inequalities.

In North America, AIDS emerged primarily among gay males and drug addicts. Consequently, "deviant" sexuality and social behavior was regarded as the prime factor leading to transmission of the disease. In Africa, however, AIDS has taken a different turn, being most often transmitted through heterosexual intercourse. Consequently, given their physiology (pregnancies and length of contact with contaminated fluids), as well as the difficulty of convincing men to use condoms, women in Africa have contracted AIDS both in greater numbers and at an earlier age than males. Yet women, more than men, are blamed for spreading the disease--especially single women who are often branded as prostitutes. Masculinity(ies), patriarchal power, and male sexual practices tend to receive less attention and blame.

AIDS, Sexuality, and Gender in Africa challenges these assumptions, arguing that AIDS cannot be understood simply as a consequence of poverty and conflict, or merely as a medical problem requiring a technical fix. Its transmission and impact are highly gendered, and, the authors argue, containing and slowing the AIDS pandemic in Africa will require both a more thorough understanding of gender relations and fundamental transformation in those relations. Without this, individual and collective efforts to halt the pandemic will be futile. As the authors point out, this undertaking is a daunting task because "the factors [which drive the epidemic] are deep-seated and intransigent, embedded in the very power relations which define male and female roles and positions, both in intimate relations or the wider society" (p. 1). While recognizing the need for short-term programs to deal with the current pandemic, the authors argue convincingly for the importance of long-term strategies to transform the fundamental gender practices driving the epidemic.

The case studies reveal both the possibilities and the limitations facing efforts to transform gender relations in Zambia and Tanzania. At the level of individuals, the research reveals widespread tension between men and women, considerable resistance encountered by wives trying to convince their husbands to use condoms, and an increasing tendency for women to see celibacy as the only means for self-preservation. Individual narratives dramatise the struggles and tensions between men and women over safe sex. Surprisingly, tensions are also high between old and young. Older women blame young people, especially women, for their promiscuity, while young men blame older men for "spoiling" (infecting) their future brides, as young women succumb to the promises of rewards for sex with wealthier, older men. The case studies demonstrate how these tensions are inhibiting both reflection and the possibility of fundamental change in gender roles and relations.

Community organization is a particular focus of the book and the comparisons are interesting. AIDS-related NGO activity is less developed in Tanzania than in Zambia, demonstrating the importance of particular contexts as Zambia is more urban and AIDS has often followed major trade and migration routes. The government of Zambia has also been more open about the AIDS problem, especially after the death of one of the president's sons due to AIDS. Support from expatriates and international development agencies has played a key role in AIDS work by NGOs in both countries. The Anti-AIDS Project in Zambia encouraged anti-AIDS clubs in schools and tertiary institutions. Sparked by a talk on AIDS given by an expatriate doctor to students at a Lusaka secondary school, the organization grew with the sponsorship of Norwegian aid (NORAD) and soon caught on around the country. International organizations, such as Rotary, have played a key role encouraging AIDS initiatives, such as the Copperbelt Health Education Project in Zambia. Churches also have played a key role in many AIDS initiatives in both countries. Community-based NGOs have demonstrated the potential of organized interventions using education, drama, training, and other techniques.

The case studies reveal problems as well. Open discussions of sexual behavior often encounter considerable censure; limited resources and contradictory donor policies often confuse and undermine community efforts. The question of voluntary versus paid workers bedevils many organizations. Some NGO activity is primarily a means for acquiring funds rather than a concerted attempt to deal with problems. Despite these problems, the book concludes that community-based NGOs and community organization are essential components in the struggle against AIDS, particularly in regard to long-term efforts to transform gender relations.

AIDS, Sexuality, and Gender in Africa is thus both an important contribution to understanding the factors fueling the current AIDS pandemic in Africa and a guide for rethinking policies and NGO activities. The book is particularly useful for evaluating the potential of women's activities, both individually and in organizations. It is less useful for considering how to address the issues of masculinity, patriarchy and male privilege/position. The book succeeds in dramatizing these issues. While Baylies and Bujra recognize that "the very hegemony of masculine definitions of sexual behaviour has become constructed as a problem for women to contend with, but not for men to confront" (p. 179), they do not analyze the factors maintaining and reinforcing male privilege. One would have liked to hear more men's voices, more analysis of masculinity(ies) and patriarchy, and more suggestions for policy and organizational strategies to deal with male privilege. However, perhaps that is the basis for another book. One can only be grateful for the fine work of this team of researchers, both for highlighting crucial and often silenced issues, especially around sexuality, and for producing in-depth research revealing the daily struggles of women and men in Africa as they seek to bring the AIDS pandemic under control. Much more work along this line is required if we are to design effective short- and long-term strategies to contain the pandemic.